Connecting Consumers to Coverage: The Role of Navigators and Consumer Assistance Programs in Implementing Health Reform in New York

This NYHealth report, developed by Empire Justice Center and the Community Service Society, untangles some of the key issues related to the Navigators and Consumer Assistance Programs designed to help individuals and small business enroll in and maintain health insurance coverage.

The Federal health reform law, the Affordable Care Act (ACA), requires that each state either establish its own state-based health insurance exchange or default to a Federal exchange by 2014. The success of New York State’s exchange will depend largely on the ability of individuals and small businesses to enroll in and maintain health insurance coverage.

The ACA directs state exchanges to establish a Navigators program to coordinate with Consumer Assistance Programs, which together are charged with providing education and enrollment assistance, helping small businesses and individuals make good coverage choices, streamline enrollment, and troubleshoot if problems arise. However, the exact parameters and relationship between the two programs remain unsettled. The report clarifies the ambiguities concerning the duties of the two programs, distills key points from discussions and research with nearly 250 stakeholders, and presents recommendations on how New York should design its Navigators and Consumer Assistance Programs to avoid duplication of efforts and best meet the needs of New Yorkers.